Venue Incident Form

CALIFORNIA MUSIC AND CULTURE ASSOCIATION, INC [CMAC]
INCIDENT REPORT FORM
PLEASE KEEP A COPY OF THIS COMPLETED FORM IN YOUR FILES AND MAIL A COPY TO
CMAC, c/o Hinman & Carmichael LLP, 260 California Street, # 1001, San Francisco, CA 94111

The purpose of this Incident Report Form is to create a database of interactions between ABC licensed venues and officers from the ABC and/or the SFPD and other enforcement agencies (i.e., Entertainment Commission, SFPD, Human Rights Commission, etc.). The information will be used to document the scope and purpose of enforcement actions in order to further the education and training of the licensed venue community and to assist in the development of venue operating standards. The information will also be useful in the defense of a venue against a criminal charge or an ABC Administrative Accusation proceeding.

DATE: ___________ TIME: _________ VENUE: _________________

ADDRESS OF VENUE: ______________________________________

ABC LICENSE TYPE: __________

SF ENTERTAINMENT PERMITS: ________________________________

WEATHER CONDITIONS: ______________________________________

SIDEWALK AND EXTERIOR CONDITIONS [TRAFFIC, PEDESTRIANS, LINES, CROWDS, ETC.]:

_________________________________________________________________________________


1. DESCRIBE INCIDENT [NARRATIVE, USE ADDITIONAL SHEETS IF NECESSARY]:
_________________________________________________________________________________




2. NAME OF PERSON ARRESTED/STOPPED/QUESTIONED [INCLUDE ADDRESS/PHONE/EMAIL ADDRESS]:________________________________________________________________________

3. PHYSICAL DESCRIPTION OF PERSON [AGE, HEIGHT, WEIGHT, HAIR/EYE COLOR, DRESS]: __________________________________________________________________________________

4. WAS IDENTIFICATION ASKED FOR? ________ WAS IDENTIFICATION SHOWN? ___________

5. DESCRIBE IDENTIFICATION [TYPE, PHYSICAL DESCRIPTION, AGE SHOWN, ETC.]

____________________________________________________________________
6. DID INDENTIFICATION MATCH PERSON? ____________________________________________

7. STATEMENTS OF PERSON [USE ADDITIONAL SHEETS IF NECESSARY]: __________________________________________________________________________________
__________________________________________________________________________________

8. NAME, AGENCY AND BADGE [STAR] NUMBER OF OFFICER: ___________________________ __________________________________________________________________________________

9. DESCRIPTION OF OFFICER [AGE, HEIGHT, WEIGHT, HAIR/EYE COLOR, DRESS (UNIFORM OR PLAIN CLOTHES)]: _______________________________________________________________________

10. OFFICER STATEMENTS [USE ADDITIONAL SHEETS IF NECESSARY: __________________________________________________________________________________ __________________________________________________________________________________

11. CRIMINAL OR ADMINISTRATIVE SECTION CITED BY OFFICER AS BASIS FOR ACTION: _____________________________________________________________________________


12. DISPOSITION OF MATTER [ARREST AND IN CUSTODY, WARNING, CITATION OR NO ACTION – ATTACH COPY OF CITATION IF ONE ISSUED]: ___________________________________________________________________________

13. WAS INCIDENT VIDEOTAPED BY SECURITY CAMERAS OR PERSONAL CELLPHONE (IF YES, WHERE IS COPY OF VIDEO?]: _____________________________________________________________________________

14. WAS ANY TESTING EQUIPMENT USED BY OFFICERS [NOISE METERS, ETC.]? IF SO PLEASE DESCRIBE:

_______________________________________________________________________
15. WERE YOU FURNISHED WITH COPIES OF TEST RESULTS? [IF SO PLEASE ATTACH]:_______________________________________________________________

16. PLEASE DESCRIBE YOUR ASSESSMENT OF THE OFFICERS [POLITE? THREATENING? PROFESSIONAL? OTHER?]: _______________________________________________________________________

17. DID THE OFFICERS ASK TO COME IN OR DID THEY JUST ENTER?

_______________________________________________________________________
18, DID YOU OR ANY MEMBER OF YOUR STAFF INVITE THE OFFICER TO ENTER?


ANY OTHER INFORMATION THAT IS RELEVANT [I.E., PRIOR EXPERIENCE WITH OFFICER, PRIOR INCIDENTS WITH OFFICER, HISTORY OF PRIOR CITATIONS, ETC.]:

__________________________________________________________


Person completing form:

name: ________________________________

title: __________________________________

venue: ________________________________

cell: _________________________________

email: ________________________________

reviewed by: _____________________(owner)